Advertisement

Position of the Academy of Nutrition and Dietetics: Benchmarks for Nutrition in Child Care

      Abstract

      It is the position of the Academy of Nutrition and Dietetics that early care and education (ECE) programs should achieve recommended benchmarks to meet children’s nutrition needs and promote children’s optimal growth in safe and healthy environments. Children’s dietary intake is influenced by a number of factors within ECE, including the nutritional quality of the foods and beverages served, the mealtime environments, and the interactions that take place between children and their care providers. Other important and related health behaviors that may influence the development of obesity include children’s physical activity, sleep, and stress within child care. Recent efforts to promote healthy eating and improve other health behaviors in ECE include national, state, and local policy changes. In addition, a number of interventions have been developed in recent years to encourage healthy eating and help prevent obesity in young children in ECE. Members of the dietetics profession, including registered dietitian nutritionists and nutrition and dietetics technicians, registered, can work in partnership with ECE providers and parents to help promote healthy eating, increase physical activity, and address other important health behaviors of children in care. Providers and parents can serve as role models to support these healthy behaviors. This Position Paper presents current evidence and recommendations for nutrition in ECE and provides guidance for registered dietitian nutritionists; nutrition and dietetics technicians, registered; and other food and nutrition practitioners working with parents and child-care providers. This Position Paper targets children ages 2 to 5 years attending ECE programs and highlights opportunities to improve and enhance children’s healthy eating while in care.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. US Census Bureau. Childcare: An important part of American life. https://www.census.gov/content/dam/Census/library/visualizations/2013/comm/child_care.pdf. Published 2013. Accessed March 30, 2018.

        • The Federal Interagency Forum on Child and Family Statistics
        America’s Children: Key National Indicators of Well-Being, 2015.
        US Government Printing Office, Washington, DC2015
      2. US Department of Agriculture. Dietary Guidelines for Americans, 2015-2020. 8th ed. https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf. Accessed March 30, 2018.

      3. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for our children: National health and safety performance standards—Guidelines for early care and education programs. http://ebooks.aappublications.org/content/caring-for-our-children-3rd-edition. Accessed April 30, 2018.

        • American Academy of Pediatrics
        Caring for Your Baby and Young Child: Birth to Age 5.
        6th ed. Bantum Publishing, New York, NY2015
        • Erinosho T.
        • Dixon L.B.
        • Young C.
        • Brotman L.M.
        • Hayman L.L.
        Nutrition practices and children's dietary intakes at 40 child-care centers in New York City.
        J Am Diet Assoc. 2011; 111: 1391-1397
        • Rasbold A.H.
        • Adamiec R.
        • Anderson M.P.
        • et al.
        Macronutrient and micronutrient intakes of children in Oklahoma child-care centres, USA.
        Public Health Nutr. 2016; 19: 1498-1505
        • Frampton A.M.
        • Sisson S.B.
        • Horm D.
        • Campbell J.E.
        • Lora K.
        • Ladner J.L.
        What's for lunch? An analysis of lunch menus in 83 urban and rural Oklahoma child-care centers providing all-day care to preschool children.
        J Am Diet Assoc. 2014; 114: 1367-1374
        • Erinosho T.O.
        • Hales D.P.
        • McWilliams C.P.
        • Emunah J.
        • Ward D.S.
        Nutrition policies at child-care centers and impact on role modeling of healthy eating behaviors of caregivers.
        J Acad Nutr Diet. 2012; 112: 119-124
        • Benjamin Neelon S.E.
        • Vaughn A.
        • Ball S.C.
        • McWilliams C.
        • Ward D.S.
        Nutrition practices and mealtime environments of North Carolina child care centers.
        Childhood Obes. 2012; 8: 216-223
        • Turner-McGrievy G.M.
        • Hales S.B.
        • Baum A.C.
        Transitioning to new child-care nutrition policies: Nutrient content of preschool menus differs by presence of vegetarian main entrée.
        J Acad Nutr Diet. 2014; 114: 117-123
        • Schwartz M.B.
        • Henderson K.E.
        • Grode G.
        • et al.
        Comparing current practice to recommendations for the Child and Adult Care Food Program.
        Child Obes. 2015; 11: 491-498
        • Larson N.
        • Ward D.S.
        • Neelon S.B.
        • Story M.
        What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts.
        J Am Diet Assoc. 2011; 111: 1343-1362
        • Maalouf J.
        • Evers S.C.
        • Griffin M.
        • Lyn R.
        Assessment of mealtime environments and nutrition practices in child care centers in Georgia.
        Child Obes. 2013; 9: 437-445
        • Copeland K.A.
        • Benjamin Neelon S.E.
        • Howald A.E.
        • Wosje K.S.
        Nutritional quality of meals compared to snacks in child care.
        Child Obes. 2013; 9: 223-232
        • Arvelo W.
        • Hinkle C.J.
        • Nguyen T.A.
        • et al.
        Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant Shigella sonnei: Implications for the management of shigellosis outbreaks among children.
        Pediatr Infect Dis J. 2009; 28: 976-980
        • Vale S.
        • Smith J.
        • Said M.
        • Mullins R.J.
        • Loh R.
        ASCIA guidelines for prevention of anaphylaxis in schools, pre-schools and childcare: 2015 update.
        J Paediatr Child Health. 2015; 51: 949-954
      4. Satter E. Ellyn Satter’s division of responsibility in feeding. https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/. Accessed April 4, 2018.

        • Ward S.
        • Belanger M.
        • Donovan D.
        • Carrier N.
        Systematic review of the relationship between childcare educators' practices and preschoolers' physical activity and eating behaviours.
        Obesity Rev. 2015; 16: 1055-1070
        • Sisson S.B.
        • Campbell J.E.
        • May K.B.
        • et al.
        Assessment of food, nutrition, and physical activity practices in Oklahoma child-care centers.
        J Acad Nutr Diet. 2012; 112: 1230-1240
        • Romo-Palafox M.J.
        • Ranjit N.
        • Sweitzer S.J.
        • et al.
        Dietary quality of preschoolers' sack lunches as measured by the Healthy Eating Index.
        J Acad Nutr Diet. 2015; 115: 1779-1788
        • Roberts-Gray C.
        • Briley M.E.
        • Ranjit N.
        • et al.
        Efficacy of the Lunch is in the Bag intervention to increase parents' packing of healthy bag lunches for young children: A cluster-randomized trial in early care and education centers.
        Int J Behav Nutr Phys Act. 2016; 13: 3
      5. Core indicators of nutritional state for difficult-to-sample populations.
        J Nutr. 1990; 120: 1559-1600
        • Coleman-Jensen A.
        • Nord M.
        • Singh A.
        Household Food Security in the United States in 2012.
        US Department of Agriculture, Economic Research Service, Washington, DC2013 (Economic Research Report-155)
        • Hanson K.L.
        • Connor L.M.
        Food insecurity and dietary quality in US adults and children: A systematic review.
        Am J Clin Nutr. 2014; 100: 684-692
        • Academy of Nutrition and Dietetics
        Position of the Academy of Nutrition and Dietetics: Nutrition guidance for healthy children ages 2 to 11 years.
        J Acad Nutr Diet. 2014; 114: 1257-1276
        • Black M.M.
        • Quigg A.M.
        • Cook J.
        • et al.
        WIC participation and attenuation of stress-related child health risks of household food insecurity and caregiver depressive symptoms.
        Arch Pediatr Adolesc Med. 2012; 166: 444-451
        • Metallinos-Katsaras E.
        • Gorman K.S.
        • Wilde P.
        • Kallio J.
        A longitudinal study of WIC participation on household food insecurity.
        Matern Child Health J. 2011; 15: 627-633
        • Mabli J.
        • Worthington J.
        Supplemental Nutrition Assistance Program participation and child food security.
        Pediatrics. 2014; 133: 610-619
        • Izumi B.T.
        • Eckhardt C.L.
        • Hallman J.A.
        • Herro K.
        • Barberis D.A.
        Harvest for Healthy Kids Pilot Study: Associations between exposure to a farm-to-preschool intervention and willingness to try and liking of target fruits and vegetables among low-income children in Head Start.
        J Acad Nutr Diet. 2015; 115: 2003-2013
        • Namenek Brouwer R.J.
        • Benjamin Neelon S.E.
        Watch Me Grow: A garden-based pilot intervention to increase vegetable and fruit intake in preschoolers.
        BMC Public Health. 2013; 13: 363
        • Dunn C.
        • Thomas C.
        • Ward D.
        • Pegram L.
        • Webber K.
        • Cullitan C.
        Design and implementation of a nutrition and physical activity curriculum for child care settings.
        Prev Chronic Dis. 2006; 3: A58
        • Lindsay A.C.
        • Salkeld J.A.
        • Greaney M.L.
        • Sands F.D.
        Latino family childcare providers' beliefs, attitudes, and practices related to promotion of healthy behaviors among preschool children: A qualitative study.
        J Obes. 2015; 2015: 409742
        • Monsivais P.
        • Johnson D.B.
        Improving nutrition in home child care: Are food costs a barrier?.
        Public Health Nutr. 2012; 15: 370-376
        • Monsivais P.
        • Rehm C.D.
        Potential nutritional and economic effects of replacing juice with fruit in the diets of children in the United States.
        Arch Pediatr Adolesc Med. 2012; 166: 459-464
        • Tovar A.
        • Mena N.Z.
        • Risica P.
        • Gorham G.
        • Gans K.M.
        Nutrition and physical activity environments of home-based child care: What Hispanic providers have to say.
        Child Obes. 2015; 11: 521-529
        • Carson R.L.
        • Baumgartner J.J.
        • Matthews R.A.
        • Tsouloupas C.N.
        Emotional exhaustion, absenteeism, and turnover intentions in childcare teachers: Examining the impact of physical activity behaviors.
        J Health Psychol. 2010; 15: 905-914
        • McGrath B.J.
        Identifying health and safety risks for childcare workers.
        AAOHN J. 2007; 55 (quiz 326-327): 321-325
        • Van Stan S.
        • Lessard L.
        • Dupont Phillips K.
        The impact of a statewide training to increase child care providers' knowledge of nutrition and physical activity rules in Delaware.
        Child Obes. 2013; 9: 43-50
        • Kakietek J.
        • Dunn L.
        • O'Dell S.A.
        • Jernigan J.
        • Kettel Khan L.
        Training and technical assistance for compliance with beverage and physical activity components of New York City's regulations for early child care centers.
        Prev Chronic Dis. 2014; 11: E177
        • Ammerman A.S.
        • Ward D.S.
        • Benjamin S.E.
        • et al.
        An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design.
        Prev Chronic Dis. 2007; 4: A67
        • Ostbye T.
        • Mann C.M.
        • Vaughn A.E.
        • et al.
        The keys to healthy family child care homes intervention: Study design and rationale.
        Contemp Clin Trials. 2015; 40: 81-89
        • Institute of Medicine
        Early Childhood Obesity Prevention Policies.
        National Academy of Sciences, Washington, DC2011
        • Liu S.T.
        • Graffagino C.L.
        • Leser K.A.
        • Trombetta A.L.
        • Pirie P.L.
        Obesity prevention practices and policies in child care settings enrolled and not enrolled in the Child and Adult Care Food Program.
        Matern Child Health J. 2016; 20: 1933-1939
      6. US Department of Agriculture. New Child and Adult Care Food Program meal patterns. https://www.fns.usda.gov/cacfp/child-and-adult-care-food-program. Accessed April 30, 2018.

      7. Child and Adult Care Food Program: Meal pattern revisions related to the Healthy, Hunger-Free Kids Act of 2010. Final rule. 81 Federal Register 24347-24383 (2016). 7 CFR 226.20.

        • Dev D.A.
        • McBride B.A.
        • Team S.K.R.
        Academy of Nutrition and Dietetics benchmarks for nutrition in child care 2011: Are child-care providers across contexts meeting recommendations?.
        J Acad Nutr Diet. 2013; 113: 1346-1353
        • Kong A.
        • Buscemi J.
        • Stolley M.R.
        • et al.
        Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year follow-up results.
        Am J Prev Med. 2016; 50: 136-144
        • American Dietetic Association. Position of the American Dietetic Association
        Benchmarks for nutrition in child care.
        J Am Diet Assoc. 2011; 111: 607-615
      8. The Nemours Foundation. Healthy kids, healthy future. https://healthykidshealthyfuture.org. Accessed March 30, 2018.

      9. Centers for Disease Control and Prevention. Spectrum of opportunities for obesity prevention in the early care and education setting (ECE). CDC technical assistance briefing document. https://www.cdc.gov/obesity/downloads/spectrum-of-opportunities-obesity-prevention.pdf. Accessed September 27, 2017.

        • Benjamin Neelon S.E.
        • Duncan D.T.
        • Burgoine T.
        • Mayhew M.
        • Platt A.
        Promoting breastfeeding in child care through state regulation.
        Matern Child Health J. 2015; 19: 745-754
        • Kim J.
        • Kaste L.M.
        • Fadavi S.
        • Benjamin Neelon S.E.
        Are state child care regulations meeting national oral health and nutritional standards?.
        Pediatr Dent. 2012; 34: 317-324
        • Mersky R.M.
        • Dunn D.J.
        Fundamentals of Legal Research.
        8th ed, revised. Foundation Press, New York, NY2002
        • Lessard L.
        • Lesesne C.
        • Kakietek J.
        • et al.
        Measurement of compliance with New York City's regulations on beverages, physical activity, and screen time in early child care centers.
        Prev Chronic Dis. 2014; 11: E183
        • Benjamin Neelon S.E.
        • Mayhew M.
        • O'Neill J.R.
        • Neelon B.
        • Li F.
        • Pate R.R.
        Comparative evaluation of a South Carolina policy to improve Nutrition in Child Care.
        J Acad Nutr Diet. 2016; 116: 949-956
      10. Institute of Child Nutrition. Child care resources. http://www.nfsmi.org/Templates/TemplateDivision.aspx?qs=cElEPTc=. Accessed April 30, 2018.

        • Benjamin Neelon S.E.
        • Duffey K.
        • Slining M.M.
        Regulations to promote healthy sleep practices in child care.
        Pediatrics. 2014; 134: 1167-1174
        • Duffey K.J.
        • Slining M.M.
        • Benjamin Neelon S.E.
        States lack physical activity policies in child care that are consistent with national recommendations.
        Child Obes. 2014; 10: 491-500
      11. Child Care Aware. Office of Child Care. http://www.childcareaware.org/starting-child-care-search/. Accessed April 30, 2018.

        • Mikkelsen M.V.
        • Husby S.
        • Skov L.R.
        • Perez-Cueto F.J.
        A systematic review of types of healthy eating interventions in preschools.
        Nutr J. 2014; 13: 56
        • Nixon C.A.
        • Moore H.J.
        • Douthwaite W.
        • et al.
        Identifying effective behavioural models and behaviour change strategies underpinning preschool- and school-based obesity prevention interventions aimed at 4-6-year-olds: A systematic review.
        Obes Rev. 2012; 13: 106-117
        • Sisson S.B.
        • Krampe M.
        • Anundson K.
        • Castle S.
        Obesity prevention and obesogenic behavior interventions in child care: A systematic review.
        Prev Med. 2016; 87: 57-69
        • Zhou Y.E.
        • Emerson J.S.
        • Levine R.S.
        • Kihlberg C.J.
        • Hull P.C.
        Childhood obesity prevention interventions in childcare settings: Systematic review of randomized and nonrandomized controlled trials.
        Am J Health Promot. 2014; 28: e92-e103
        • Benjamin Neelon S.E.
        • Ostbye T.
        • Hales D.
        • Vaughn A.
        • Ward D.S.
        Preventing childhood obesity in early care and education settings: Lessons from two intervention studies.
        Child Care Health Dev. 2016; 42: 351-358
        • Hoffman J.A.S.E.
        • Wirth C.
        • Johnson S.
        • Sobell S.
        • Pelissier K.
        • Harris D.
        • Izumi B.
        Farm to preschool: The state of the research literature and a snapshot of national practice.
        J Hunger Environ Nutr. 2016; 12 (4,443-465)
        • Ward D.S.
        • Benjamin S.E.
        • Ammerman A.S.
        • Ball S.C.
        • Neelon B.H.
        • Bangdiwala S.I.
        Nutrition and physical activity in child care: Results from an environmental intervention.
        Am J Prev Med. 2008; 35: 352-356
        • Alkon A.
        • Crowley A.A.
        • Neelon S.E.
        • et al.
        Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children's body mass index.
        BMC Public Health. 2014; 14: 215
        • Battista R.A.
        • Oakley H.
        • Weddell M.S.
        • Mudd L.M.
        • Greene J.B.
        • West S.T.
        Improving the physical activity and nutrition environment through self-assessment (NAP SACC) in rural area child care centers in North Carolina.
        Prev Med. 2014; 67: S10-S16
        • Martin S.L.
        • Martin M.W.
        • Cook B.
        • Knaus R.
        • O'Rourke K.
        Notes from the field: The evaluation of Maine Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) experience.
        Eval Health Prof. 2015; 38: 140-145
        • Drummond R.L.
        • Staten L.K.
        • Sanford M.R.
        • et al.
        A pebble in the pond: The ripple effect of an obesity prevention intervention targeting the child care environment.
        Health Promot Pract. 2009; 10: 156s-167s
        • Natale R.A.
        • Lopez-Mitnik G.
        • Uhlhorn S.B.
        • Asfour L.
        • Messiah S.E.
        Effect of a child care center-based obesity prevention program on body mass index and nutrition practices among preschool-aged children.
        Health Promot Pract. 2014; 15: 695-705
        • Tandon P.S.
        • Saelens B.E.
        • Christakis D.A.
        Active play opportunities at child care.
        Pediatrics. 2015; 135: e1425-e1431
        • Ward D.S.
        Physical activity in young children: The role of child care.
        Med Sci Sports Exerc. 2010; 42: 499-501
        • De Craemer M.
        • De Decker E.
        • De Bourdeaudhuij I.
        • et al.
        Correlates of energy balance-related behaviours in preschool children: A systematic review.
        Obes Rev. 2012; 13: 13-28
        • Vanderloo L.M.
        Screen-viewing among preschoolers in childcare: A systematic review.
        BMC Pediatr. 2014; 14: 205
        • Pate R.R.
        • O'Neill J.R.
        • Brown W.H.
        • Pfeiffer K.A.
        • Dowda M.
        • Addy C.L.
        Prevalence of compliance with a new physical activity guideline for preschool-age children.
        Child Obes. 2015; 11: 415-420
        • Goldfield G.S.
        • Harvey A.
        • Grattan K.
        • Adamo K.B.
        Physical activity promotion in the preschool years: A critical period to intervene.
        Int J Environ Res Public Health. 2012; 9: 1326-1342
        • Reilly J.J.
        Physical activity, sedentary behaviour and energy balance in the preschool child: Opportunities for early obesity prevention.
        Proc Nutr Soc. 2008; 67: 317-325
        • Hemmingsson E.
        A new model of the role of psychological and emotional distress in promoting obesity: Conceptual review with implications for treatment and prevention.
        Obes Rev. 2014; 15: 769-779
        • Nielsen L.S.
        • Danielsen K.V.
        • Sorensen T.I.
        Short sleep duration as a possible cause of obesity: Critical analysis of the epidemiological evidence.
        Obes Rev. 2011; 12: 78-92
        • Wu Y.
        • Gong Q.
        • Zou Z.
        • Li H.
        • Zhang X.
        Short sleep duration and obesity among children: A systematic review and meta-analysis of prospective studies.
        Obes Res Clinic Pract. 2017; 11: 140-150
        • Komada Y.
        • Asaoka S.
        • Abe T.
        • et al.
        Relationship between napping pattern and nocturnal sleep among Japanese nursery school children.
        Sleep Med. 2012; 13: 107-110
        • Staton S.L.
        • Smith S.S.
        • Pattinson C.L.
        • Thorpe K.J.
        Mandatory naptimes in child care and children's nighttime sleep.
        J Dev Behav Pediatr. 2015; 36: 235-242
        • Dockray S.
        • Susman E.J.
        • Dorn L.D.
        Depression, cortisol reactivity, and obesity in childhood and adolescence.
        J Adolesc Health. 2009; 45: 344-350
        • Berry D.
        • Blair C.
        • Ursache A.
        • et al.
        Child care and cortisol across early childhood: Context matters.
        Dev Psychol. 2014; 50: 514-525
        • Sumner M.M.
        • Bernard K.
        • Dozier M.
        Young children's full-day patterns of cortisol production on child care days.
        Arch Pediatr Adolesc Med. 2010; 164: 567-571